Schizophrenia (SZ) is a severe and frequent mental disorder that has multifactorial origins (genetic but also environmental vulnerability, gene environment interactions). Our team has shown that in France smoking is common among these patients and often begins before the onset of symptoms. This calls into question the hypothesis of self-medication of psychotic symptoms and cognitive disorders by tobacco consumption, and raises the question of specific interactions between nicotine consumption and the genes of the dopaminergic and cholinergic nicotinic systems, in particular with regard to adolescence, period of neurodevelopmental vulnerability.

to study (i) the interactions between the DA system and exogenous nicotine in a pre-clinical mouse model (transgenic for DAT) (ii) the impact of smoking on the psychotic and clinical phenotype in a national cohort of SZ patients (iii) interactions between tobacco consumption and several genetic polymorphisms of the dopaminergic and nicotinic system in SZ population. Hypothesis: Disruption of the balance between DA and nicotine systems by nicotine consumption in adolescence may be a key neurobiological mechanism for the emergence of SZ disorders.

The characterization of the model is behavioral (anxiety, memory, social interactions, locomotion, motor coordination) but also biochemical. For the clinical approach, we exploit the clinical / cognitive / genetic data of a national cohort (Fondamental foundation) and another smaller and local cohort.

We demonstrate, for the clinical study, that some clinical and cognitive characteristics are associated with tobacco use in schizophrenia patients, with more cognitive distubrances in smokers, against the self medication hypothesis. Genes envionment interactions also demonstrate associations with genes involved in dopaminergic system. Regarding the preclinical study, we show a gene environment interaction, as heterozygote mice for the DAT gene exposed to Nicotine durig a critical neurodevelopmental window ( adolescence) show a loss of familiarity in the social memory test and a loss of cognitive flexibility at the set shifting test, similar to what is found in schizophrenia.

TBetter characterization of patients with schizophrenia is necessary to better understand the physiopathology of this disease and explore new personalized preventive and therapeutical targets. We show that tobacco is associated with cognitive disturbances in schizophrenia patients, against selfmedication hypothesis; and in our animal model, that nicotine exposition during the adolescence combined to a moderate cortical and limbic hyperdopaminergia, is associated with persistent cognitive and social deficits, in favor of a gene environment interaction.

None Declared

Tobacco use is common in subjects with schizophrenia (SZ) and has sometimes been associated with better functioning in short-term studies. Only few studies embrace an extensive examination of tobacco influence on clinical, cognitive and therapeutic characteristics in stabilized SZ outpatients. The objective of the present study was to assess the association between cognitive performances and smoking status in SZ subjects.

In total, 1233 SZ participants (73.9% men, mean age 31.5) were included and tested with a comprehensive battery. Tobacco status was self-declared (never-, ex-, or current smokers). Multivariable analyses including principal component analyses (PCA) were used.

In total, 53.7% were smokers with 33.7% of them nicotine-dependent. Multiple factor analysis revealed that current tobacco smoking was associated with impaired general intellectual ability and abstract reasoning (aOR 0.60, 95% IC 0.41–0.88, p = 0.01) and with a lifetime alcohol use disorder (p = 0.026) and a lifetime cannabis use disorder (p < 0.001). Ex- and never-smokers differed for age, mean outcome, cannabis history and medication [ex-smokers being older (p = 0.047), likely to have higher income (p = 0.026), a lifetime cannabis use disorder (p < 0.001) and higher CPZeq doses (p = 0.005)]. Premorbid IQ in the three groups significantly differed with, from higher to lower: ex-smokers, never-smoker, current smokers (all p < 0.001).

This study is the largest to date providing strong evidence that chronic smoking is associated with cognitive impairment in SZ, arguing against the self-medication hypothesis as a contributor to the high prevalence of smoking in SZ. Ex-smokers may also represent a specific subgroup. Longitudinal studies are warranted to determine the developmental impact of tobacco on neurocognition.

There have been over 900,000 deaths from COVID-19, with more than 3 million people bereaved. These deaths are associated with factors leading to poor bereavement outcomes, and distress in frontline-staff

to (i)present the rapid implementation of an intervention for bereavement support; (ii)characterize first calls and follow-up.

We recruited a multidisciplinary team and prepared a structure called “SIB” (Support and Intervention for Bereavement) in a matter of days. There were three steps for the support (Screening, First-line intervention, Second-line intervention (short follow-up). We collected data screening risk factors for complicated grief (CG).

Between March 24th-May 14th (lockdown, March 16th-May 13th), the hotline received nineteen calls for an intervention. The hospital contacts were various, including mortuary. Fifteen relatives were followed, among them thirteen bereaved for ten deaths (on 52 deaths=19.23%). Dead persons were young (m=59.68 years-old, SD=15.25). All contacts reported several risk factors for a CG (no “goodbye” (100%), no funeral rituals (82.35%)). Six relatives were addressed for short follow-up.

The actual pandemic is at high risk for complicated grief and may until 2021. We hope that all hospitals would implement basic bereavement outreach programs to prepare families for the death and to support them afterwards, as well as provide basic support to frontline staff.

No significant relationships.

During the Covid Outbreak, the deployment of psychiatric phone-based consultations (PbC) became a large necessity.

The main objective of our study was to assess, 4 months after the end of the lockdown, the degree of satisfaction of the PbCs compared to that of usual face-to-face consultations (FC) in young adults presenting a first episode of psychosis (FEP) or entering schizophrenia (SCZ).

All patients beneficiated from PbCs conducted by hospital care staff during lockdown. A 15-items questionnaire evaluating satisfaction was carried out remotely (score ranging from 1 to 10). Primary outcome was satisfaction with consultation allowing the comparison of a group preferring FC (FC+) against a group in favor or equivalent of PbC (PbC +).

30 patients were recruited (mean age 26.93 years old (4.9 SD), Male 56%. Diagnoses were SCZ 60% and FEP 40%. 20/30 participants belonged to (FC+) group. Total scores of satisfaction for the PbC differed between the (PbC+) group (mean 9 (1.69 SD)) and (FC+) group (mean 6.80, (1.32 SD)) p < 0.05. The (FC+) group tends to have PbC more frequently (40%) than the (PbC+) group (10%) and to find the phone interface more stressfull (40%) than the PbC+ group (10%). The (FC+) group tends to less wish (40%) PbC follow up in future than the (PbC+) group (90%).

This study shows that the PbCs were favorably evaluated by a third of the patients. The anxiety-inducing experience of the PbC in the (FC+) group could be explained by the severity of their pathology.

The determinants of quality of life (QoL) in schizophrenia are largely debated, mainly due to methodological discrepancies and divergence about the concepts concerned. As most studies have investigated bi- or tri-variate models, a multivariate model accounting for simultaneous potential mediations is necessary to have a comprehensive view of the determinants of QOL. We sought to estimate the associations between cognitive reserve, cognition, functioning, insight, depression, schizophrenic symptoms, and QoL in schizophrenia and their potential mediation relationships.

We used structural equation modeling with mediation analyses to test a model based on existing literature in a sample of 776 patients with schizophrenia from the FondaMental Foundation FACE-SZ cohort.

Our model showed a good fit to the data. We found better functioning to be positively associated with a better QoL, whereas better cognition, better insight, higher levels of depression, and schizophrenic symptoms were associated with a lower QoL in our sample. Cognitive reserve is not directly linked to QoL, but indirectly in a negative manner via cognition. We confirm the negative relationship between cognition and subjective QoL which was previously evidenced by other studies; moreover, this relationship seems to be robust as it survived in our multivariate model. It was not explained by insight as some suggested, thus the mechanism at stake remains to be explained.

The pathways to subjective QoL in schizophrenia are complex and the determinants largely influence each other. Longitudinal studies are warranted to confirm these cross-sectional findings.